Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/075—Ethers or acetals
  • A61K31/08—Ethers or acetals acyclic, e.g. paraformaldehyde
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/74—Synthetic polymeric materials
  • A61K31/765—Polymers containing oxygen
  • A61K31/77—Polymers containing oxygen of oxiranes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/74—Synthetic polymeric materials
  • A61K31/765—Polymers containing oxygen
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/04—Antineoplastic agents specific for metastasis
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07C—ACYCLIC OR CARBOCYCLIC COMPOUNDS
  • C07C43/00—Ethers; Compounds having groups, groups or groups
  • C07C43/02—Ethers
  • C07C43/03—Ethers having all ether-oxygen atoms bound to acyclic carbon atoms
  • C07C43/04—Saturated ethers
  • C07C43/10—Saturated ethers of polyhydroxy compounds
  • C07C43/11—Polyethers containing —O—(C—C—O—)n units with ≤ 2 n≤ 10
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
  • C08L71/00—Compositions of polyethers obtained by reactions forming an ether link in the main chain; Compositions of derivatives of such polymers
  • C08L71/02—Polyalkylene oxides
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
  • C08L2203/00—Applications
  • C08L2203/02—Applications for biomedical use

Definitions

• the present invention concerns compositions for use in the prophylaxis and/or treatment of squamous cell carcinomas such as head and neck squamous cell carcinoma (HNSCC).
• HNSCC head and neck squamous cell carcinoma
• the present invention also concerns methods for preventing and/or treating such carcinomas.
• Other aspects, objects and advantages of the present invention will be apparent from the description below.
• Head and neck cancer is estimated to have caused approximately 7900 deaths in the U.S. in 2010 (Pfister D.G ef a/; J. Natl. Compr. Cane. Netw. 201 1 ; 9:596-650).
• Common risk factors for developing this disease include the smoking or chewing of tobacco, consumption of alcohol, chewing of betel nut and/or infection with human papillomavirus (HPV).
• HNSCC head and neck squamous cell carcinoma accounts for approximately 3 percent of all cancers in the United States.
• HNSCC includes any cancer of the head and neck that begins in squamous cells (thin, flat cells that form the surface of the skin, eyes, various internal organs, and the lining of hollow organs and ducts of some glands). HNSCC is associated with high rate of death and morbidity. This aggressive epithelial malignancy implicates the mucosal lining of the upper aerodigestive track including the oral cavity, oropharynx and larynx.
• HNSCC Nonsteroidal anti-inflammatory drugs
• retinoic acid beta-carotene
• HNSCC patients have a worsening quality of life due to debilitating changes in facial appearance, speech, swallowing and breathing.
• the present invention is based, at least in part, on an observation that polyethylene glycol (PEG) exhibits antiproliferative activity in HNSCC.
• PEG polyethylene glycol
• a method for preventing and/or treating squamous cell carcinoma, particularly HNSCC in a subject comprising administering to the subject an effective amount of polyethylene glycol (PEG).
• PEG polyethylene glycol
• the present invention provides a method for preventing and/or treating HNSCC in a subject comprising administering to the subject an effective amount of PEG, wherein the PEG suitable for use in the method preferably has an average molecular weight between about 1 000 daltons and 20,000 daltons, preferably between about 2000 daltons and 9,000 daltons, more preferably between about 3000 and 8000, most preferably about 3350, 4000 or 8,000.
• the invention provides a composition for use in the prophylaxis and/or treatment of HNSCC as described in various aspects and embodiments of the invention herein, the composition comprising (e.g. as its sole therapeutically active constituent) an effective amount of PEG.
• the composition may comprise PEG having an average molecular weight as described herein.
• the present invention provides a method for preventing and/or treating HNSCC in a subject comprising topically administering to said subject an effective amount of PEG. Compositions for use in such a method are also provided.
• the present invention provides a method for reducing or suppressing HNSCC initiation and/or proliferation in a subject comprising topically administering to the region of the subject afflicted with HNSCC and/or a pre- malignant lesion and/or oral leukoplakia, an effective amount of PEG.
• Compositions for use in such a method are also provided.
• the present invention provides a method for preventing and/or treating HNSCC in a subject comprising locoregionally
• compositions for use in such a method are also provided.
• the present invention further provides a composition for locoregional use in the prevention and/or treatment of HNSCC in a subject afflicted with said disease wherein the composition comprises an effective amount of PEG.
• a method for preventing and/or treating HNSCC in a subject wherein the effective amount of PEG is administered to the subject from 1 to 5 time(s) a day, preferably 2 to 4 times a day, more preferably 3 times a day.
• Compositions for use in such a method are also provided.
• the present invention provides a method for reducing or suppressing HNSCC proliferation in the head and neck of a subject comprising administering to the subject an effective amount of PEG to one or more of: the lip, oral cavity (including the tongue, buccal mucosa, alveolar ridge, retromolar trigone, gums, floor of mouth, hard palate), salivary glands, nasal cavity (including
• nasopharynx paranasal sinuses
• pharynx including oropharnyx such as the base of tongue, soft palate, tonsillar pillar and fossa
• hypopharnyx including pyriform sinus, lateral pharyngeal wall, posterior pharyngeal wall, postcricoid pharynx
• larynx including supraglottis (e.g. false cords, arytenoids, epiglottis, arytenoepiflottic fold), glottis, subglottis) of the subject.
• supraglottis e.g. false cords, arytenoids, epiglottis, arytenoepiflottic fold
• glottis subglottis
• the present invention further provides methods for preventing and/or treating HNSCC in a subject as described in various aspects and embodiments of the invention herein, wherein the HNSCC has afflicted one or more of: the lip, oral cavity (including the tongue, buccal mucosa, alveolar ridge, retromolar trigone, gums, floor of mouth, hard palate), salivary glands, nasal cavity (including nasopharynx), paranasal sinuses, pharynx (including oropharnyx such as the base of tongue, soft palate, tonsillar pillar and fossa) hypopharnyx (including pyriform sinus, lateral pharyngeal wall, posterior pharyngeal wall, postcricoid pharynx), and larynx
• compositions for use in such methods are also provided.
• a preferred embodiment of the invention is a method for preventing and/or treating HNSCC in a subject wherein the HNSCC has afflicted the oral cavity (or anatomical site thereof) comprising administering (for example locoregionally administering) to the oral cavity an effective amount of PEG.
• administering for example locoregionally administering
• Compositions for use in such a method are also provided.
• the present invention provides a method for reducing or inhibiting Epidermal Growth Factor Receptor (EGFR) surface expression and/or phosphorylation of the receptor in the squamous cells of the head and neck of a subject, the method comprising administering to the subject an effective amount of PEG.
• EGFR Epidermal Growth Factor Receptor
• Compositions for use in such a method are also provided.
• the present invention comprises a method for preventing and/or treating HNSCC in a subject which method comprises co-administering to the subject an effective amount of PEG with an effective amount of one or more additional therapeutic agent(s).
• Compositions for use in this method comprising an effective amount of PEG, optionally further comprising the one or more additional therapeutic agent(s) are also provided.
• a method for preventing and/or treating HNSCC in a subject comprises administering to said subject: (a) an effective amount of a therapeutic agent such as an anti-EGFR agent (for example an anti-EGFR antibody such as cetixumab);
• a therapeutic agent such as an anti-EGFR agent (for example an anti-EGFR antibody such as cetixumab);
• step (a) occurs before step (b). In other embodiments of this aspect of the invention, step (a) occurs after step (b). In further embodiments of this aspect of the invention, step (a) and step (b) occur concurrently.
• a method for preventing and/or treating HNSCC in a subject in remission of HNSCC comprising administering to the subject an effective amount of PEG.
• the subject may be in partial or complete remission.
• Compositions for use in such a method are also provided.
• a method for ameliorating (such as preventing) the recurrence of HNSCC in a subject in remission of that disease comprising administering to the subject an effective amount of PEG.
• Compositions for use in such a method are also provided.
• a method for preventing and/or treating metastatic HNSCC in a subject which method comprises
• compositions for use in such a method are also provided.
• a method for preventing and/or treating locally advanced HNSCC in a subject which method comprises administering to the subject an effective amount of PEG.
• compositions for use in such a method are also provided.
• a method for regressing a squamous cell carcinoma in a subject which method comprises (a) administering an effective amount of PEG.
• Compositions for use in such a method, such as described herein, are also provided.
• the squamous cell carcinoma is HNSCC.
• the squamous cell carcinoma over- expresses EGFR.
• the EGFR expression status of the squamous cell carcinoma may be determined according to standard methods, techniques and kits such as described herein.
• the method further comprises (b) resecting and/or ablating the squamous cell carcinoma and/or administering an effective amount of a therapeutic agent.
• step (b) may occur after step (a).
• the present invention may reduce the degree of trauma or treatment related adverse events to the subject resulting from subsequent therapeutic procedures.
• a method for preventing and/or treating HNSCC in a subject comprising;
• step (a) occurs before step (b). In another embodiment, step (b) occurs before step (a).
• the invention further provides the use of an effective amount of PEG in the manufacture of a medicament, for example the compositions described herein, for the treatment and/or prophylaxis of HNSCC.
• the invention further provides the use of an effective amount of PEG in the manufacture of a medicament, for example the compositions described herein, for regressing a squamous cell carcinoma such as HNSCC.
• Figure 1 A graph depicting the antiproliferative activity of PEG 8000 in SCC-25 cells in vitro, a model for HNSCC.
• SCC-25 cells were seeded in a 96-well plate and then treated with different concentrations of PEG 8000 (0.62mM (0.5% w/v) to 12.5 mM (1 0% w/v) for 24h. Changes in the cellular proliferation (cell number) were assayed by using a standard WST-1 assay (Roche Diagnostics, Indianapolis, IN). The experiments were performed in triplicate for 3 determinations. The data are presented as mean + S.D.;+ p ⁇ 0.05, *p ⁇ 0.001 compared to vehicle alone.
• Figure 2 A graph depicting the effects of PEG 3350 or 8000 on the levels of membrane (surface) epidermal growth factor receptor (EGFR) expression in SCC-9 and SCC-25 cells.
• SCC-9 and SCC-25 cells were treated with a 5% w/v solution of PEG 3350, or with a 5% w/v solution of PEG 8000.
• the cells were trypsinized, stained for surface expression of EGFR and subjected to flow cytometric analysis.
• the experiments were performed in triplicate for 3 determinations. The data are presented as mean + S.D.; x p ⁇ 0.01 , * p ⁇ 0.001 compared to corresponding control.
• Figure 3 A graph depicting the results of in vivo topical administration of PEG-8000 on the inhibition of tumor progression in the rat 4-Nitroquinoline 1 -oxide (4NQO) model of head and neck squamous cell cancer.
• 4NQO 4-Nitroquinoline 1 -oxide
• rats were given ad libitum access to 4NQO (20 ppm)-supplemented water. After 14 weeks, the rats were switched to regular water and randomized equally into PEG or vehicle-treated control groups. The rats either received a daily (3 to 4 minute) topical application of 10% PEG 8000 or PBS (vehicle control) in the oral cavity (tongue, buccal floor/roof). The rats were euthanized after 14 weeks; tongues were excised and subjected to macroscopic assessment of tumor burden, assessing both tumor number ( Figure 3 upper panel) and tumor volume ( Figure 3 lower panel). The data are presented as mean + S.D.
• Figure 4 A series of photographs comparing the palates and tongues of animals exposed to 4NQO only (top panel, left to right), or both 4NQO and PEG 8000 (bottom panel, left to right). The photographs reflect the reduced tumor volume in PEG 8000 treated tissue compared to vehicle treated rats as depicted in Figure 3.
• Figure 5 A series of photomicrographs of immunohistochemically stained sections of 4NQO treated rat tongue showing the effect of oral topical application of PEG 8000 on the premalignant epithelial hyperproliferation.
• the formalin-fixed and H&E stained samples were subjected to pathological evaluation.
• the H&E stained sections from 4NQO-treated rats showed a number of localized regions of mild-to-moderate epithelial dysplasia that was normalized in PEG 8000 treated rats.
• the tissue sections were subjected to immunohistochemical analyses of the nuclear antigen Ki67, a well- defined marker of proliferation (lower panel).
• FIG. 6 A photomicrograph depicting the effect of topical application of PEG 8000 on the expression of EGFR.
• the formalin-fixed tongue sections from control (carcinogen-untreated) and PEG-8000 treated or untreated 4NQO-rats were subjected to immunohistochemical assessment of EGFR expression.
• baseline EGFR expression in the tongue mucosa of 4NQO rats was significantly higher than that of control (non-carcinogen treated) rats (p ⁇ 0.00001 ).
• Topical application of PEG 8000 to 4NQO rats caused a significant reduction in the expression of EGFR compared to PEG-untreated 4NQO-rats (p ⁇ 0.005).
• the control and 4NQO-PEG sections have little or no staining for EGFR, whereas the 4NQO section is heavily stained for EGFR.
• FIG. 7, 8 and 9 Graphs depicting reduced cellular proliferation and EGFR expression by different PEG formulations (PEG 3350, PEG 4000 and PEG 8000) in SCC-25 cells.
• the cells were seeded either in 96-well plates (WST-1 assay) or 60 mm cell culture dishes (EGFR and PCNA expression). Cells were treated separately with PEG 3350 ( Figure 7), PEG 4000 ( Figure 8) and PEG 8000 ( Figure 9) for 24h.
• the cellular proliferation was determined by both WST-1 assay and measuring the cellular proliferation marker Proliferating Cell Nuclear Antigen (PCNA) by Western blotting.
• PCNA Cell Nuclear Antigen
• EGFR expression was also determined by Western blotting. All the experiments were performed in triplicate. For WST-1 assay each experiment had 1 2 determinations, while for EGFR and PCNA measurements there were 3
• the data are presented as mean percent of control (no PEG treatment) for the respective biomarkers (WST-1 , EGFR, and PCNA) + S.E.M. ; * p ⁇ 0.05 and x p ⁇ 0.0001 .
• Figure 10 A graph depicting the inhibition of surface expression of EGFR by different PEG formulations (PEG 3350, PEG 4000 and PEG 8000) in SCC-9 cells.
• PEG 3350, PEG 4000 and PEG 8000 PEG 3350, PEG 4000 and PEG 8000
• SCC-9 cells were treated with 10% w/v PEG for 24h and subjected to flow cytometric analysis to determine the expression of surface EGFR.
• the histograms are presented as percent of control (no PEG treatment) for the surface expression of EGFR.
• the experiments were performed in triplicate with 4 determinations each.
• the data are presented as mean percent of control (no PEG treatment) + S.E.M.; * p ⁇ 0.0001 .
• Figures 1 1 and 12 Graphs depicting the effect of PEG 8000 on proliferation and EGFR expression in human papillomavirus (HPV) (-) and HPV (+) cells.
• HPV human papillomavirus
• Figure 1 1 HPV (-) OKF 6 cells
• Figure 1 2 HPV (+) HOK cells
• the cellular proliferation was determined by both WST-1 assay and measuring the cellular proliferation marker PCNA by Western blotting.
• EGFR expression was also determined by Western blotting. All the experiments were performed in triplicate.
• FIGS 13, 14 and 1 5 In order to study the effect of PEG on the regression of tumor growth, an orthotopic model was utilized, in which approximately 1 million SCC-25 cells were directly implanted near the tongue region of athymic mice. Two weeks later the mice were randomly divided into two groups of 12 animals each and subjected to daily oral topical application of 10% w/v PEG 8000 or PBS using a Q- tip. The mice were euthanized 19 to 20 days post treatment and tumors excised and weighed. PEG-8000 caused a significant decrease in the tumor weight compared to control (29.8%; * p ⁇ 0.05, Figure 13). Also evaluated were the Ki-67 proliferation marker and EGFR immunostaining in the tongue sections.
• compositions of the invention may comprise an effective amount of PEG as its sole therapeutically active constituent or may contain one or more therapeutic agents (particularly anti-cancer agents) as described in more detail below.
• therapeutic agents particularly anti-cancer agents
• polyethylene glycol PEG
• PEG poly(oxyethylene) or poly(ethylene oxide)
• PEO poly(ethylene oxide)
• the polyethylene glycol (PEG) used in the invention typically has the general formula H-(OCH 2 CH 2 ) n OH, although other polyethylene glycol compounds may be used such as end-capped structures and polyoxyethylenes that include minor amounts of alkylene oxide units other than ethylene oxide.
• the polyethylene glycol (PEG) used in compositions of the invention may have an average molecular weight (for example a weight average molecular weight), in a range wherein the lower limit of the range is selected from the group consisting of: 1000, 2000, 3000, 4000, 6000; and an upper limit of the range is, selected independently, from the group consisting of: 3000, 4000, 5000, 6000, 7000, 8000, 9000, 10,000, 12,000, 15,000, 20,000.
• Preferred ranges are wherein the lower limit is 3000 or 4000 and the upper limit is, selected independently, 5000, 6000, 7000, 8000 or 9000.
• the PEG may be PEG 3350, PEG 4000 or PEG 8000 as defined in some national or regional pharmacopias.
• suitable PEGs recognized in some national or regional pharmacopoias include Macrogols, for example Macrogol 3350, Macrogol 4000, Macrogol 8000.
• the PEG is not systemically absorbed to any significant extent when topically administered to the subject.
• compositions of the present invention may further comprise other constituents such as another therapeutic agent (see below), and one or more excipients.
• excipients include one or more electrolytes such as sodium chloride, potassium chloride, sodium bicarbonate, sulphate such as sodium sulphate.
• compositions of the invention comprise sodium chloride and potassium chloride and optionally sodium bicarbonate.
• Compositions of the invention may comprise one or more sweetener(s) (such as aspartame, acesulfame potassium (acesulfame K), sucralose and saccharine and combinations thereof) and one or more flavouring(s) (such as orange, lemon-lime, lemon, citrus, chocolate, tropical fruit, aloe vera, tea, strawberry, grapefruit, blackcurrant, pineapple and vanilla).
• sweetener(s) such as aspartame, acesulfame potassium (acesulfame K), sucralose and saccharine and combinations thereof
• flavouring(s) such as orange, lemon-lime, lemon, citrus, chocolate, tropical fruit, aloe vera, tea, strawberry, grapefruit, blackcurrant, pineapple and vanilla.
• Compositions may further comprise ascorbate and/or citrate.
• compositions of the invention may further comprise preservatives and other additives such as, for example, antimicrobials, anti-oxidants, carriers, chelating agents, and inert gases and the like as known and called for by acceptable galenic practice.
• the carrier is a pharmaceutically acceptable carrier.
• the carrier can be any of those conventionally used and is limited only by chemico-physical considerations, such as solubility and lack of reactivity with the PEG and/or other therapeutic agents (if present) and by the route of administration.
• Pharmaceutically acceptable carriers are well-known to those skilled in the art and are readily available. It is preferred that the pharmaceutically acceptable carrier be one which is chemically inert to the active agent(s) and one which has no detrimental side effects or toxicity under the conditions of use.
• compositions of the invention may be presented in a variety of preparations.
• compositions of the invention may be prepared in the form of an aqueous solution or suspension (for example a mouthwash), emulsion, paste (e.g.
• compositions of the invention include solutions, suspensions, linctus and paints. Depending on the intended use of the composition of the invention, certain preparations may be particularly apt.
• compositions of the invention may be prepared as a lip balm or cream.
• a mouthwash, spray or lozenge may be particularly appropriate.
• the preparation is a mouthwash, it maybe gargled or swirled around the mouth before swallowing or expelling.
• compositions of the invention may be prepared as an aerosol preparation, particularly for nasal, buccal and oropharynx administration.
• Compositions of the invention may also be prepared as
• the composition of the invention may be a linctus preparation, a preparation form well known to those skilled in the art. This form may assist in increasing the contact time between PEG and the target tissue (such as the pharynx and/or larynx mucosa) and may be particularly appropriate in the prophylaxis and/or treatment of HNSCC at these anatomical sites.
• compositions of the invention are administered topically to the subject.
• Topical administration in the context of the present invention, refers to the application of a composition of the invention to a surface of the subject's body.
• Topical administration includes application to an internal surface of the subject, for example the buccal mucosa.
• Compositions of the present invention may be administered to the target area (e.g. the carcinoma) and in the local region thereof (sometimes referred to herein and in the art as "locoregional administration").
• compositions of the present invention are applied to a region of the carcinoma that is accessible at the surface of subject's body, for example, surface exposed HNSCC that has afflicted the lip, tongue, buccal mucosa (e.g. buccal floor and/or roof), nasal cavity, pharynx, larynx and anatomical sites thereof.
• Topical administration may include per os administration of compositions of the invention.
• topical administration may include swallowing a composition of the invention. Accordingly, contact between the composition of the invention and the surface exposed region of the carcinoma (if present) is enabled as the composition passes into the stomach via the pharynx.
• An effective amount of PEG to be employed therapeutically will depend, for example, upon the therapeutic and treatment objectives (e.g. prophylaxis or treatment or both), the route of administration, the age, body mass, condition of the subject undergoing treatment or therapy (for example, by determining the subject's performance status), stage and/or aggressiveness (e.g. TNM score) of the carcinoma (if present), any auxiliary or adjuvant therapies being provided to the subject, and on the subjects previous response (if appropriate) to therapy with compositions of the invention.
• An effective amount of PEG may be determined, at least in part, by the desired reduction in EGFR surface expression in the target tissue (for example, a HNSCC carcinoma).
• An effective amount of PEG may produce in the target tissue a reduction in EGFR expression of at least 30% (or thereabout), for example, at least 40%, compared to the expression observed prior to contact with PEG.
• Reduction of EGFR surface expression in a target tissue such as a carcinoma may be influenced by the contact time between PEG and the target tissue.
• a greater reduction in EGFR surface expression in the target tissue may be observed with increased contact time.
• contact time between PEG and the target tissue may be from 5 seconds to 1 0 minutes, e.g. 1 to 5 minutes such as 2 to 3 minutes.
• An effective amount of PEG may therefore be titrated accordingly.
• the degree of EGFR reduction may be determined using methods described in the examples herein. In particular, the degree of EGFR reduction may be determined using flow cytometry as described below.
• the EGFR expression status of a target tissue may be determined using standard methods and kits (for example EGFR pharmDxTM, available from Dako Denmark A/S, Glostrup, Denmark).
• An effective amount of PEG for use in the prophylaxis of HNSCC may differ from an effective amount of PEG for use in the treatment of HNSCC.
• a lower amount of PEG is required than typically used in a treatment setting. Since PEG is already widely used in the medical field and is well tolerated, the risk of serious adverse events is considered to be low. Since the present inventors have demonstrated that PEG is capable of inhibiting proliferation of HNSCC cells in vitro in a concentration dependent manner (see below), it is within the purview of the ordinarily skilled person to determine the effective amount of PEG according to the considerations described above.
• compositions of the invention may comprise an effective amount of PEG.
• aqueous solutions of the invention such as a mouthwash
• Compositions of the invention comprising an effective amount of PEG may be administered one or more times per day, for example, twice per day, three times, four times or five times per day.
• the duration of therapy with compositions of the invention depends, in part, on the considerations given above. Such considerations are within the purview of the attending physician or healthcare professional.
• compositions of present invention comprising an effective amount of PEG may be used in conjunction with one or more therapeutic agents for the prophylaxis and/or treatment of HNSCC.
• compositions of the invention may be coadministered with the one or more therapeutic agent(s).
• coadministered means the coordinated administration of compositions of the invention with one or more therapeutic agents to prevent and/or treat HNSCC.
• Such coordinated administration between compositions of the invention and one or more therapeutic agent(s) may be simultaneous, sequential or separate.
• therapeutic agents that may be used in conjunction with compositions of the invention include radiation therapy and anti-cancer agents.
• anticancer agent means a therapeutic agent that is capable of inhibiting the initiation and/or proliferation of cancer and/or promoting cell death (e.g. by apoptosis) in cancer cells such as squamous cell carcinomas, particularly those of the head and neck.
• Such therapeutic agents include those approved by national or regional regulatory authorities for such use.
• anti-cancer agents include agents that target EGFR expression and/or function (for example by inhibiting functional signaling of the EGFR), herein referred to as "anti-EGFR" agents".
• anti-EGFR agents include anti-EGFR antibodies such as cetixumab, panitumumab, zalutumab, nimotuzumab.
• Other anti- EGFR agents include Erlotinib, Gefitinib, Lapatinib, BIBW-2992.
• anti-cancer agents include agents that target VEGFR expression and/or function ("anti-VEGFR agents").
• anti-VEGFR agents include agents that target VEGFR expression and/or function.
• anti-VEGFR agents include anti-VEGFR agents that target VEGFR expression and/or function.
• anti-cancer agents include agents that target IGF-1 R expression and/or function ("anti-IGF-1 R agents").
• anti-IGF-1 R agents include
• anti-cancer agents include agents that inhibit the mammalian target of rapamycin ("mTOR agents").
• mTOR agents agents that inhibit the mammalian target of rapamycin
• examples of such mTOR agents include
• anti-cancer agents include platinating agents such as cisplatin and carboplatin; taxanes such as paclitaxel and docetaxel; folate anti-metabolites such as pemetrexed; fluorouracil, methotrexate.
• compositions of the present invention comprise an effective amount of PEG together (for example in intimate physical admixture) with an effective amount of one or more anti-cancer agents such as described above.
• the PEG is not conjugated to the anti-cancer agent.
• the reader of this specification may assume that each combination of PEG together with one or more of the anti-cancer agents described above is individually and specifically
• an effective amount of one or more therapeutic agent(s) need not necessarily be the same weight amount as an effective amount of PEG. It will also be apparent that when considering the term "effective amount” in relation to radiation therapy, an appropriate dose unit (for example gray (gy) or rad) should be deployed.
• an appropriate dose unit for example gray (gy) or rad
• kits comprising a composition of the invention together with at least one composition of one or more anti-cancer agents such as described above, optionally together with instructions for use. Methods of treatment and compositions for use in such methods.
• the present invention provides a method for preventing and/or treating HNSCC in a subject comprising administering an effective amount of PEG.
• the present invention also provides compositions for use in the prophylaxis and/or treatment of HNSCC in a subject.
• compositions and treatment methods of the present invention may be of particular use in treating squamous cell carcinomas such as HNSCC that over-express surface EGFR.
• the EGFR expression status of a squamous cell carcinoma in a subject may be determined according to standard methods and kits (for example EGFR pharmDxTM, available from Dako Denmark A/S, Glostrup, Denmark).
• the method is for preventing HNSCC.
• the method is for treating HNSCC.
• the method is for preventing and treating HNSCC.
• prophylaxis and “preventing” and grammatical variations thereof means inhibiting the initiation of HNSCC (or, as the case may be, cancer of the esophagus) and/or inhibiting the progression of a pre-malignant pathology of the epithelium (such as oral leukoplakia) and/or early stage carcinoma to a later stage carcinoma.
• prophylaxis methods of the invention are performed prior to a positive diagnosis of HNSCC.
• treat and grammatical variations thereof means inhibiting the proliferation of HNSCC (or, as the case may be, cancer of the esophagus) and/or promoting cell death in HNSCC (or, as the case may be, a cancer of the esophagus).
• treat includes "cure", although the term cure does not necessarily mean the complete restoration of health with respect to the malignancy.
• a treatment may have varying degrees of curative effect and as such are encompassed by the term "treat”.
• the present invention further provides a method for preventing HNSCC in a subject in remission of that disease comprising administering to the subject a composition of the invention.
• the remission may be total or partial.
• Compositions for use in such a method are also provided.
• the present invention further provides a method for treating locally advanced and/or metastatic HNSCC in a subject comprising administering to the subject a
• a method for preventing and/or treating HNSCC in a subject susceptible to developing HNSCC comprising administering to the subject a composition of the invention.
• Such subjects include those with a history and/or concurrent use of: tobacco (smoking and/or chewing), heavy alcohol intake, betel nut chewing.
• Such subjects include those that are infected with HPV (particularly with serotype HPV 16) and/or immunocompromised and/or with a prior or familial history of (or predisposition to) developing HNSCC.
• the invention further provides a method for preventing and/or treating HNSCC in a subject that is HPV negative comprising administering to the subject a composition of the invention. Compositions for use in such methods are also provided.
• compositions for use in such a method are also provided.
• a method for preventing HNSCC in a subject afflicted with pre-malignant alterations to the epithelium of the upper aerodigestive tract comprising administering to the subject a composition of the invention.
• Pre-malignant alterations may arise as a result of "field cancerization".
• Field cancerization refers to a process whereby the epithelium undergoes alterations (which may be multiple and independent of one another) that primes the epithelium for transformation. These alterations may be evident in subtle changes to the epithelium vasculature, cellular dysplasia and other molecular changes to the epithelium.
• This embodiment may be particularly apt in preventing HNSCC in subjects with a prior history of (or predisposition to) HNSCC.
• a squamous cell carcinoma such as HNSCC in a subject which method comprises:
• a therapeutic agent such as radiation therapy and/or an anti-cancer agent, e.g. an anti-EGFR agent (for example an anti-EGFR antibody such as cetixumab);
• an anti-EGFR agent for example an anti-EGFR antibody such as cetixumab
• step (b) and step (a) occur concurrently.
• step (b) occurs after step (a).
• step (b) occurs before step (a).
• the method further comprises the step of (c) administering an effective amount of a therapeutic agent e.g. radiation therapy and/or an anti-cancer agent such as an anti-EGFR agent (for example, an anti-EGFR antibody such as cetixumab).
• a therapeutic agent e.g. radiation therapy and/or an anti-cancer agent
• an anti-EGFR agent for example, an anti-EGFR antibody such as cetixumab
• step (b) may occur after step (a) and before step
• an effective amount of PEG may be administered between cycles of treatment with other therapeutic agents, particularly radiation and/or anti-cancer agents.
• the therapeutic agents of step (a) and step (c) need not necessarily be the same. Where the therapeutic agents of step (a) and step (c) are the same, the posology followed in step (a) and step (c) need not necessarily be the same.
• an effective amount of PEG may be used to treat HNSCC in a subject in conjunction with resection and/or ablation of a HNSCC carcinoma. Accordingly, there is provided a method for treating HNSCC in a subject comprising the steps of:
• Step (b) administering an effective amount of PEG.
• Step (a) may occur either before step (b) or after step (b).
• step (c) comprising the step of administering an effective amount of a therapeutic agent as described herein.
• Step (c) may occur after step (a) and before, after or concurrently with step (b).
• an effective amount of PEG may be administered at the site(s) and local region of the surgical resection/ablation e.g. locoregional administration. In some embodiments of the invention, an effective amount of PEG may be administered (e.g. locoregionally administered) to a lesion of the head and neck suspected of being afflicted with HNSCC.
• the present invention further provides methods for the multi-modal treatment of HNSCC (that is treatment involving at least two different modalities for treating HNSCC, e.g. surgery, radiotherapy, chemotherapy) the method comprising administering an effective amount of PEG.
• the present invention provides a method for reducing or inhibiting EGFR expression and/or phosphorylation in the squamous cells of the head and neck of a subject, by administering to the subject an effective amount of PEG.
• the dosages and duration of use is dependent on the amount of reduction of EGFR expression or phosphorylation desired.
• PEG is administered to the subject at least 1 to 14 days, however PEG can be administered for a longer period, or until the reduction of expression and/or phosphorylation of EGFR in the squamous cell tissues is achieved.
• a method for preventing and/or treating cancer of the esophagus in a subject comprising administering to the subject an effective amount of PEG.
• Compositions, such as described above, for use in such a method are also provided.
• a method for reducing the tumor burden i.e. tumor number and volume
• a squamous cell carcinoma such as HNSCC
• the subject referred to in the inventive methods can be any subject.
• the subject is a mammal.
• the term "mammal” refers to any mammal, including, but not limited to, mammals of the order Rodentia, such as mice and hamsters, and mammals of the order Logomorpha, such as rabbits. It is preferred that the mammals are from the order Carnivora, including Felines (cats) and Canines (dogs). It is more preferred that the mammals are from the order Artiodactyla, including Bovines (cows) and Swines (pigs) or of the order Perssodactyla, including Equines (horses). It is most preferred that the mammals are of the order Primates, Ceboids, or Simoids (monkeys) or of the order Anthropoids (humans and apes). An especially preferred mammal is human, such as a male human.
• the dissected rat tongues were examined for the presence of overt tumors. Total number of tumors (> 0.2 cm) on each tongue were counted and the tumor volume (size) was measured according to the formula width x length x height x ⁇ /6
• mice were procured from Charles River (MA).
• SCC-25 cells [1 x 10 6 cells in 50 ⁇ DMEM F1 2 media (ATCC)] were directly injected into the upper tongue region of the mice. Two weeks later, when the tumors started appearing, the mice were randomly divided into two groups of 12 animals each and subjected to once- daily oral topical application of 10% w/v PEG 8000 (-100 ⁇ _) or PBS using a Q-tip.
• mice were euthanized 19 to 20 days post treatment under C0 2 exposure/bilateral thoracotomy and tumors excised and weighed.
• Tumor and tongue tissues were formalin fixed, paraffin embedded/mounted before staining with hematoxylin and eosin. Histopathological evaluation confirmed the squamous nature of the tumors. Also evaluated were the proliferation marker Ki-67 and EGFR by immunostaining of the tongue sections.
• Tissue sections were subjected to IHC analysis to determine the effect of PEG 8000 on the expression of proliferation marker Ki-67 and EGFR.
• Four micron paraffin- embedded sections were mounted on Superfrost + slides (Vector Laboratories, Burlingame, CA) and deparaffinized first by baking at 55-60 °C for 1 hour, and then subjecting to two 5 minute washes in xylene.
• the tissue sections were then hydrated in graded series of ethanol rinses.
• the epitope retrieval was performed by subjecting the tissue slides to pressure microwaving (NordicWare, Minneapolis, MN) in antigen unmasking solution (Vector Laboratories).
• Endogenous peroxide activity was quenched by treating with 3% H 2 0 2 in methanol for 1 0 minutes, and the nonspecific binding was blocked by incubating the tissue sections with 5% horse serum for 2 hours at room temperature. Sections were then incubated at 4°C for 4h with primary antibodies anti-Ki-67 (RB-9043-P, 1 :300 Thermo Scientific UK), and anti-EGFR (SC-03, 1 :200 Santa Cruz Biotechnology, Santa Cruz, CA), followed by appropriate biotinylated secondary antibodies.
• the antigen-antibody complexes were detected with the Vectastatin Elite ABC kit (Vector Laboratories) using 3, 3'-diaminobenzidine (DAB) as chromagen (Invitrogen, CA).
• DAB 3, 3'-diaminobenzidine
• sections were processed in the absence of the primary antibodies. Specimens were counterstained in Gill's hematoxylin solution and the blue color stabilized by a 20 second wash in saturated lithium carbonate (1 g/100 ml).
• Immunohistochemistry (IHC) was scored by a pathologist with no prior knowledge of the treatment plan. A semiquantitative scale was used to evaluate immunoreactivity of basal squamous epithelial cells. The extent of staining was graded and scored as 0, negative staining; 1 +, ⁇ 1 0% reactivity, 2+ 10-50% reactive, and 3+ for > 50% positive reactivity. Cell Culture.
• SCC-25 and SCC-9 cells (American Type Tissue Culture, Rockville, MD) were cultured in DMEM/F-12 media (containing 2.5 mM L-glutamine, 15 mM HEPES, 0.5 mM sodium pyruvate, and 1 200 mg/l sodium bicarbonate) supplemented with 400ng/ml of hydrocortisone (Sigma/Adrich), 10% v/v FBS (ATCC), and 0.5% v/v Pen/Strep (ATCC).
• the OKF-6 (HPV-) and HOK (HPV+) cells were cultures in keratinocytes-SFM media (Life Technologies).
• WST-1 Cell Proliferation Assay
• SCC-25 cells (2,000 cells/well) were seeded in a 96-well plate and then treated with different
• This example demonstrates that different formulations of PEG inhibit EGFR expression in SCC-9 and SCC-25 cells in vitro.
• Example 3 This example demonstrates that administration of PEG 8000 inhibits tumor progression in the rat 4NQO model of squamous cell cancer.
• the rat 4NQO-induced oral carcinogenesis model used in these studies, has a number of features that are histo-pathologically comparable to human head and neck cancer.
• This model by systemic administration of 4NQO in drinking water, produces a range of preneoplastic and neoplastic lesions and has been used in number of chemopreventive studies.
• the rats were randomized into two groups, receiving daily oral topical application (painting the buccal floor/roof of rat oral cavity using a sable brush #4 for up to 3-4 minutes) of either (a) vehicle (PBS) or (b) PEG-8000 (10% w/v) for an additional 14 consecutive weeks.
• PBS vehicle
• PEG-8000 10% w/v
• This example depicts how PEG 8000 inhibits epithelial cell hyperproliferation.
• PEG 8000 treatment reduced the number of Ki-67 cells in the supra-basal compartment; the remaining Ki-67 cells were restricted mostly to the basal layer as seen in the control group (figure 5 lower panel).
• This example illustrates how PEG 8000 down regulates EGFR in the carcinogen initiated rat tongue sections.
• Example 6 The tongues of the rats in Example 3 were sectioned and stained with an antibody to EGFR and subjected to IHC analysis as described above. Treatment with PEG 8000 significantly reduced expression of EGFR as observed on the sections. As illustrated in Figure 6, the control and 4NQO-PEG sections have little or no staining for EGFR, whereas the 4NQO sections were heavily stained for EGFR. The results show, histologically, that treatment with PEG appears to down-regulate EGFR expression in the rat 4NQO model.
• This example illustrates the potential chemopreventive efficacy of topical oral application of PEG 8000 on the development of esophageal tumors.
• PEG 8000 may also provide secondary protection against the development of esophageal tumors. This could be expected due to a partial salivary wash of PEG into the esophagus.
• the 4-NQO (4-nitroquinoline 1 -Oxide) rat model of head and neck cancer was utilized as for example 3, 4 and 5. This model is known to initiate esophageal tumors. The esophagus was very carefully separated from the trachea and subjected to tumor count.
• Example 7 This example concerns the comparative effect of different PEG formulations on cellular proliferation and EGFR expression in SCC 25 cells.
• squamous carcinoma cells SCC-25 were seeded either in 96 well plates (WST-1 assay) or 60 mm cell culture dishes (Western blotting). The cells were then treated for 24h with PEG 3350, PEG 4000 and PEG 8000 using concentrations ranging from 0 to 10% w/v ( Figures 7, 8 and 9
• This example illustrates the effect of different PEG formulations on surface expression of EGFR in SCC 9 cells.
• SCC-9 cells were treated for 24h with 10% w/v PEG ( PEG 3350, PEG 4000, or PEG 8000). After treatment, the cells were trypinized and subjected to flow cytometric analysis for membrane (surface) expression of EGFR. The results showed a highly significant decrease in surface expression of EGFR in cells treated with all the PEG formulations tested ( Figure 10). These results further support the hypothesis that the anti-proliferative property of PEG may be related to its anti-EGFR activity.
• Example 9 This example concerns the effect of PEG 8000 on etiologically heterogeneous HNSCC.
• HNSCC human papilloma virus
• HPV human papilloma virus
• cell lines were utilized having different HPV status to study the effect of PEG on EGFR down-regulation and cell proliferation.
• the two cell lines used in these experiments were premalignant hTERT-immortalized cells that are HPV negative [HPV (-) OKF-6; Figure 1 1 ] and premalignant HPV transfected immortalized human oral keratinocytes (HOK) that express E6 [HPV (+) HOK; Figure 12].
• This example concerns the effect of topical application of PEG 8000 on the development of orthotopic tumors in athymic mice.
• mice In order to study the effect of PEG 8000 on the inhibition of tumor growth, an orthotopic model was utilized in which squamous cell carcinoma (SCC-25, approximately one million) were directly implanted near the tongue region of athymic mice (immuno compromised, B-cell deficient). Two weeks post inoculation, the mice were randomly divided into two groups (12 mice each) and subjected to daily oral topical application of 10% w/v PEG 8000 or PBS (vehicle) using a Q-tip (2-3 min). During the treatment period, PEG 8000 did not cause any significant change in body weights compared to control (data not shown). At necropsy (1 9-20 days post treatment), the tumors were excised and weighed.
• SCC-25 squamous cell carcinoma

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